Healthcare Provider Details

I. General information

NPI: 1134741366
Provider Name (Legal Business Name): MICAH ELIZABETH HOFMANN MS, LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2020
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8072 NORMANDY DR
FT RILEY KS
66442-7069
US

IV. Provider business mailing address

26509 THUNDER RD APT 1
FT RILEY KS
66442-3550
US

V. Phone/Fax

Practice location:
  • Phone: 785-239-3627
  • Fax:
Mailing address:
  • Phone: 913-360-9523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number0000001697
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: